International Targets for Poverty Reduction and Food Security: A Mildly Sceptical But Resolutely Pragmatic View With a Call for Greater Subsidiarity

Summaries International development targets adopted by UN Conferences provide political impetus, focus expenditure and help in monitoring progress. However, simple targets can misrepresent complex realities and distort policy. Monitoring targets can have a high opportunity cost. Political impetus can be lost if targets are over?ambitious. Food security illustrates the uses of targets and the risks involved. Simple hunger or nutrition targets have been attractive to policymakers but have been problematic conceptually, and routinely overambitious in practice. Greater subsidiarity may be the answer, with simple international targets being used as a platform for local action. Subsidiarity means more than developing national action plans to implement international targets: it is potentially more open, participatory subversive and deviant

Monitoring of National Drug Policy (NDP) and its standardized indicators; conformity to decisions of the national drug selecting committee in Iran

BACKGROUND: Pharmaceuticals have made an important contribution to global reductions in morbidity and mortality. To help save lives and improve health, it is important to be sure about equity to access to drugs, drug efficacy, quality and safety, and rational use of drugs, which are standardized National Drug Policy (NDP) objectives. NDP's indicators are useful to evaluate the pharmaceutical system performance in a country. Iran has adapted a National Drug List (NDL). Since management of drug supply in Iran takes place only for drugs that have been selected in NDL and this list is selected by the member of Iran Drug Selecting Committee (IDSC), thus evaluation of IDSC's decision making during last 5 years is an appropriate way to evaluate the implementation of drug supply system in the country. METHODS: To identify strengths and weaknesses of pharmaceutical policy formation and implementation in Iran, four standard questionnaires of the World Health Organization (WHO) were used. To assess the agreement between decisions of IDSC and standardized NDP indicators in the last 5 years (1998–2002), a weighted questionnaire by nominal group technique based on the questions that should be answered during discussion about one drug in IDSC was designed and used. RESULTS: There is a totally generics based NDP with 95% local production, that provides affordable access to drugs. The system, structures, and mechanisms were in place; however, they did not function properly in some topics. Assessment of 59 dossiers of approved drugs for adding to NDL during last 5 years showed that IDSC's members pay more attention to efficacy, safety, and rationality in use rather than accessibility and affordability. CONCLUSION: Revision of drug system in term of implementation of the processes to achieve NDP's objectives is necessary to save public health. Clarification of NDP's objectives and their impact for IDSC's members will result in improvement of the equity in access to pharmaceuticals

Breast-milk iodine concentration declines over the first 6 mo postpartum in iodine-deficient women.

BACKGROUND: Little is known about the iodine status of lactating mothers and their infants during the first 6 mo postpartum or, if deficient, the amount of supplemental iodine required to improve status. OBJECTIVE: The objective was to determine maternal and infant iodine status and the breast-milk iodine concentration (BMIC) over the first 6 mo of breastfeeding. DESIGN: A randomized, double-blind, placebo-controlled supplementation trial was conducted in lactating women who received placebo (n = 56), 75 μg I/d (n = 27), or 150 μg I/d (n = 26) after their infants' birth until 24 wk postpartum. Maternal and infant urine samples and breast-milk samples were collected at 1, 2, 4, 8, 12, 16, 20, and 24 wk. Maternal serum thyrotropin and free thyroxine concentrations were measured at 24 wk. RESULTS: Over 24 wk, the median urinary iodine concentration (UIC) of unsupplemented women and their infants ranged from 20 to 41 μg/L and 34 to 49 μg/L, respectively, which indicated iodine deficiency (ie, UIC < 100 μg/L). Mean maternal UIC was 2.1-2.4 times higher in supplemented than in unsupplemented women (P < 0.001) but did not differ significantly between the 2 supplemented groups. BMIC in the placebo group decreased by 40% over 24 wk (P < 0.001) and was 1.3 times and 1.7 times higher in women supplemented with 75 μg I/d (P = 0.030) and 150 μg I/d (P < 0.001), respectively, than in unsupplemented women. Thyrotropin and free thyroxine did not differ significantly between groups. CONCLUSION: BMIC decreased in the first 6 mo in these iodine-deficient lactating women; supplementation with 75 or 150 μg I/d increased the BMIC but was insufficient to ensure adequate iodine status in women or their infants. The study was registered with the Australian New Zealand Clinical Trials Registry as ACTRN12605000345684

The path of least resistance: Paying for antibiotics in non-human uses

Antibiotic resistance is a critical threat to human and animal health. Despite the importance of antibiotics, regulators continue to allow antibiotics to be used in low-value applications - subtherapeutic dosing in animals, and spraying tobacco plants for blue mold, for example - where the benefits are unlikely to outweigh the costs in terms of increased resistance. We explore the application of a user fee in non-human uses of antibiotics. Such a fee would efficiently deter low value uses while also providing funding to support the development of the urgently needed new antibiotics

Generating political commitment for ending malnutrition in all its forms: A system dynamics approach for strengthening nutrition actor networks.

Generating political commitment for ending all forms of malnutrition represents a key challenge for the global nutrition community. Without commitment, the policies, programs, and resources needed to improve nutrition are unlikely to be adopted, effectively implemented, nor sustained. One essential driver of commitment is nutrition actor network (NAN) effectiveness, the web of individuals and organizations operating within a given country who share a common interest in improving nutrition and who act collectively to do so. To inform new thinking and action towards strengthening NAN effectiveness, we use a systems dynamics theoretical approach and literature review to build initial causal loop diagrams (CLDs) of political commitment and NAN effectiveness and a qualitative group model building (GMB) method involving an expert workshop to strengthen model validity. First, a "nutrition commitment system" CLD demonstrates how five interrelated forms of commitment-rhetorical, institutional, operational, embedded, and system-wide-can dynamically reinforce or diminish one another over time. Second, we present CLDs demonstrating factors shaping NAN effectiveness organized into three categories: actor features, resources, and capacities; framing strategies, evidence, and norms; and institutional, political, and societal contexts. Together, these models generate hypotheses on how political commitment and NAN effectiveness could be strengthened in future and may provide potential starting points for country-specific conversations for doing so

Reducing the environmental impact of trials: a comparison of the carbon footprint of the CRASH-1 and CRASH-2 clinical trials

BACKGROUND: All sectors of the economy, including the health research sector, must reduce their carbon emissions. The UK National Institute for Health Research has recently prepared guidelines on how to minimize the carbon footprint of research. We compare the carbon emissions from two international clinical trials in order to identify where emissions reductions can be made. METHODS: We conducted a carbon audit of two clinical trials (the CRASH-1 and CRASH-2 trials), quantifying the carbon dioxide emissions produced over a one-year audit period. Carbon emissions arising from the coordination centre, freight delivery, trial-related travel and commuting were calculated and compared. RESULTS: The total emissions in carbon dioxide equivalents during the one-year audit period were 181.3 tonnes for CRASH-1 and 108.2 tonnes for CRASH-2. In total, CRASH-1 emitted 924.6 tonnes of carbon dioxide equivalents compared with 508.5 tonnes for CRASH-2. The CRASH-1 trial recruited 10,008 patients over 5.1 years, corresponding to 92 kg of carbon dioxide per randomized patient. The CRASH-2 trial recruited 20,211 patients over 4.7 years, corresponding to 25 kg of carbon dioxide per randomized patient. The largest contributor to emissions in CRASH-1 was freight delivery of trial materials (86.0 tonnes, 48% of total emissions), whereas the largest contributor in CRASH-2 was energy use by the trial coordination centre (54.6 tonnes, 30% of total emissions). CONCLUSIONS: Faster patient recruitment in the CRASH-2 trial largely accounted for its greatly increased carbon efficiency in terms of emissions per randomized patient. Lighter trial materials and web-based data entry also contributed to the overall lower carbon emissions in CRASH-2 as compared to CRASH-1. TRIAL REGISTRATION NUMBERS: CRASH-1: ISRCTN74459797CRASH-2: ISRCTN86750102

Submission from the CGIAR System Organization, the World Business Council for Sustainable Development (WBCSD), the French National Institute for Agricultural Research (INRA) and the World Bank, in response to Decision 4/CP.23.

This submission on Improved nutrient use and manure management towards sustainable and resilient agricultural systems proposes a set of priority action areas for consideration by the Koronivia Joint Work on Agriculture to further the agenda

Iodine status in pre-school children prior to mandatory iodine fortification in Australia

The iodine status of children between the ages of 5 and 15 years has been routinely assessed in many countries, but few studies have examined iodine status in pre-school children. We conducted a cross-sectional study of pre-school children living in Adelaide, South Australia, between 2005 and 2007. Children 1–5 years old were identified using a unique sampling strategy to ensure that the study population was representative. A 3-day weighed diet record, a blood sample and a urine sample were obtained from each child. The median urinary iodine concentration (UIC) of the children (n = 279) was 129 µg L⁻¹, indicating iodine sufficiency (normal range: 100–199 µg L⁻¹), but 35% of the children had a UIC < 100 µg L−1. The median thyroglobulin concentration of children (n = 217) was 24 µg L⁻¹ and thyroglobulin concentration declined with increasing age (P = 0.024). The mean daily iodine intake was 76 µg. The intake of iodine was lower than expected and highlights difficulties in accurately assessing iodine intakes. Further studies are needed to monitor dietary changes and iodine status in this age group since the implementation of mandatory fortification of bread with iodised salt in Australia in 2009.Sheila Skeaff, Ying Zhao, Robert Gibson, Maria Makrides, Shao Jia Zho

A cross-sectional survey of urinary iodine status in Latvia

Publisher Copyright: © 2014 Lithuanian University of Health Sciences. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.Background and objective: A nationwide survey of schoolchildren was conducted to detect regional differences in urinary iodine excretion in Latvia and to compare the results with data from the newborn thyroid-stimulating hormone (TSH) screening database as well with the results of a similar study performed in Latvia 10 years ago. Materials and methods: We conducted a cross-sectional school-based cluster survey of 915 children aged 9-12 years in 46 randomly selected schools in all regions of Latvia. Urine samples, questionnaires on the consumption of iodized salt and information on socioeconomic status were collected. TSH levels in newborns were also measured. Results: The median creatinine-standardized urinary iodine concentration (UIC) in our study was 107.3 mg/g Cr. UIC measurements indicative of mild iodine deficiency were present in 31.6%, moderate deficiency in 11.9% and severe deficiency in 2.8% of the participants. The prevalence of iodine deficiency was the highest in the southeastern region of Latgale and the northeastern region of Vidzeme. The prevalence of TSH values >5 mIU/L followed a similar pattern. The self-reported prevalence of regular iodized salt consumption was 10.2%. Children from urban schools had a significantly lower UIC than children from rural schools. Conclusions: Our findings suggest that although the overall median UIC in Latvian schoolchildren falls within the lower normal range, almost 50% of the schoolchildren are iodine deficient, especially in urban schools and in the eastern part of Latvia. The absence of amandatory salt iodization program puts a significant number of children and pregnantwomen at risk.publishersversionPeer reviewe